阿仑膦酸对前列腺癌雄激素阻断治疗引起骨质流失的疗效

目的 进一步验证前列腺癌雄激素阻断治疗与骨质疏松的关系,对阿仑膦酸防治由前列腺癌雄激素阻断治疗所引起骨质流失的作用进行评估.方法 选取2007年4月至2008年4月收治完成骨密度测定并接受雄激素阻断治疗的前列腺癌患者112例,将其按随机数字表法分为A、B两组,每组56例.A组患者服用阿仑膦酸钠并补充元素钙,而B组患者仅每天补充元素钙.在开始去势治疗后6、12个月分别对两组患者腰椎、髋部和股骨颈进行骨密度测定.结果 两组患者年龄、去势持续时间、血清前列腺特异抗原水平以及不良反应方面比较差异均无统计学意义(P＞0.05).两组血清睾酮维持在去势水平例数比较差异无统计学意义(P＞0.05).用药12个月后,B组腰椎骨密度下降了1.4%(95% CI-2.70%～-0.03%,P=0.045),髋部下降了0.7%(95% CI-1.50%～-0.01%,P=0.052),股骨颈下降了0.7%(95% CI-1.50%～0.10%,P=0.081).与之相对应,A组腰椎骨密度增加了3.7%(95% CI 2.80%～4.60%,P＜0.01),髋部增加了0.7%(95% CI 0.10%～1.40%,P=0.031),股骨颈增加了1.6%(95% CI 0.40%～2.80%,P=0.008).两组骨密度变化比较差异有统计学意义(P＜0.01).结论 阿仑膦酸可有效防治由前列腺癌雄激素阻断治疗所引起的骨质流失.

Antiosteoporotic efficacy of orally alendronate in men with prostate cancer receiving combined androgen blockade

Objective To study osteoporosis in patients receiving androgen deprivation therapy (ADT) with prostate cancer, and determine whether once-weekly oral alendronate can prevent bone loss in men receiving ADT. Methods One hundred and twelve men with nonmetastatic prostate cancer receiving ADT were divided into two groups from April 2007 to April 2008, 56 cases in each group. Group A took alendronate (70 rng once-weekly orally) and calcium supplement, group B received calcium supplement only. Bone mineral density (BMD) were measured both before and 6 months, 12 months after treatment for both groups. Results There were no statistically differences in age, persistence time of castration, prostate specific antigen level and adverse effect between two groups(P＞ 0.05). At baseline, 39.3%(44/112) of men had osteoporosis and 51.8%(58/112) had low bone mass. After 12 months treatment, in group A, BMD increased 3.7% (95% CI 2.80% to 4.60% ,P＜0.01 ) at the spine,0.7%(95% CI 0.10% to 1.40% ,P=0.031)at the total hip and 1.6% (95% CI0.40% to 2.80%,P =0.008) at the femoral neck. In group B decreased 1.4% (95% CI-2.70% to -0.03%, P = 0.045 ) at the spine, 0.7% (95% CI - 1.50% to -0.01%,P = 0.052) at the total hip and 0.7% (95% CI -1.50% to 0.10%, P = 0.081 ) at the femoral neck. The estimated changes in BMD were significantly different between two groups (P ＜ 0.01 ). Conclusions It suggests that ADT induce bone loss which should be treated in early stage. Bone loss that occurred with ADT is prevented and improved with once-weekly oral alendronate.